In 2018, the results of multiple phase III trials in metastatic renal cell carcinoma (mRCC) were presented. A phase III noninferiority trial demonstrated the importance of careful patient selection before cytoreductive nephrectomy. Additionally, three randomized phase III trials demonstrated the superiority of combination therapy with an immune-checkpoint inhibitor backbone versus sunitinib in patients with treatment-naive mRCC.
Careful patient selection is critical for patients with metastatic renal cell carcinoma (mRCC) being considered for cytoreductive nephrectomy and should be discouraged in patients with poor-risk mRCC who have a high burden of extrarenal disease4.
A phase III trial comparing ipilimumab and nivolumab versus sunitinib in first-line intermediate-risk and poor-risk mRCC demonstrated an overall survival benefit for patients receiving ipilimumab and nivolumab6.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Barata, P. C. & Rini, B. I. Treatment of renal cell carcinoma: current status and future directions. CA Cancer J. Clin. 67, 507–524 (2017).
Flanigan, R. C. et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N. Engl. J. Med. 345, 1655–1659 (2001).
Heng, D. Y. C. et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur. Urol. 66, 704–710 (2014).
Méjean, A. et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N. Engl. J. Med. 379, 417–427 (2018).
Motzer, R. J. et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N. Engl. J. Med. 373, 1803–1813 (2015).
Motzer, R. J. et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N. Engl. J. Med. 378, 1277–1290 (2018).
Motzer, R. J. et al. IMmotion151: a randomized phase III study of atezolizumab plus bevacizumab versus sunitinib in untreated metastatic renal cell carcinoma (mRCC) [abstract]. J. Clin. Oncol. 36 (Suppl. 6), 578 (2018).
Escudier, B. et al. Patient-reported outcomes (PROs) in IMmotion151: atezolizumab (atezo) + bevacizumab (bev) versus sunitinib (sun) in treatment (tx) naive metastatic renal cell carcinoma (mRCC) [abstract]. J. Clin. Oncol. 36 (Suppl. 15), 4511 (2018).
Motzer, R. J. et al. JAVELIN renal 101: a randomized, phase III study of avelumab + axitinib versus sunitinib as first-line treatment of advanced renal cell carcinoma (aRCC) [abstract]. Ann. Oncol. 29 (Suppl. 8), LBA6_PR (2018).
Rini, B. I. et al. Molecular correlates differentiate response to atezolizumab (atezo) + bevacizumab (bev) versus sunitinib (sun): results from a phase III study (IMmotion151) in untreated metastatic renal cell carcinoma (mRCC) [abstract]. Ann. Oncol. 29 (Suppl. 8), LBA31 (2018).
M.C.O. has received fees as a consultant of Bristol-Myers Squibb, Exelixis, Eisai and Pfizer. B.I.R. has received fees as a consultant of Bristol-Myers Squibb, Merck and Pfizer.
About this article
Cite this article
Ornstein, M.C., Rini, B.I. Radical shifts in the first-line management of metastatic renal cell carcinoma. Nat Rev Clin Oncol 16, 71–72 (2019). https://doi.org/10.1038/s41571-018-0146-4
Current Treatment Options in Oncology (2021)